Reforming Medical Education

Originally posted 6-17-2010:
One of the more interesting tidbits I heard at the NPSF Conference was the belief that medical schools are not teaching enough about patient safety.  The Lucian Leape Institute released a paper outlining five concepts that are fundamental to improving safety in the healthcare system.  The first of the five items the Institute addressed was medical education reform.  The group recently released a white paper addressing their recommendations on medical education reform entitled, "Unmet Needs: Teaching Physicians to Provide Safe Patient Care"

Members of the Lucian Leape Institute held a panel to discuss their recommendations at the conference.  I got the feeling from the discussion that medical schools have been very focused on the technical aspects of medicine without teaching much about safety issue.  Some of the recommendations presented included a need to place a higher priority on patient safety, as well as promoting teamwork and collaboration.  There was a lot of discussion around teaching and integrating patient safety science throughout the entire medical education experience.  The University of Central Florida has recently opened a new medical school, and they are trying to include these recommendations in their teaching philosophy.  For example, there has been a strong focus on the importance of handwashing included in their Microbiology course.  The discussions gave me a sense that this philosophy has been well received by the UCF students, and it may promote a safety focused cultural change.

I have seen patient safety education in Pharmacy school.  A little over a year ago, I attended the "Safety and Quality in the Medication Use System" course at the University of Wisconsin. The course was split into teaching the Human Factors principles behind patient safety and the application of them in pharmacy.  It addressed  many of the major safety concerns currently in pharmacy, while provided tools and methodologies to develop solutions. Even though the first half was a lot of review, I found the course to be helpful to better understand the safety issues of pharmacy.  I came to find out that I was in the minority among my classmates.

The course was required for all 3rd year pharmacy students before they started their clerkships.  The safety research presented was coming at the tail end of their classroom education at a time when they were pretty burned out.  Most of the students that I talked to felt there wasn't much value to the course and were more interested in learning more about drug interactions and other technical aspects of their field.  Whenever we did group exercises that looked at the root cause analysis of a medication error, my teammates generally would quip, "maybe the lighting was bad."  They seemed to think bad lighting was always a safe answer to provide as a reason for an error to occur in a pharmacy. (To be fair, that is sometimes part of the reason.) I found it disheartening to see such a cynical attitude coming from the students.  A few of the students would tell me they did not quite understand why they were learning engineering principles in the class. Some students could tell it was important, but just didn't want to deal with it as they really needed to focus on their other courses.  I actually approached the instructors to get their take.  What I was pleased to learn was the instructors were always listening to the comments and suggestions to improve the course in the future.  They admitted that the timing of when they taught the safety principles may have been coming late in their education, and could relate to the overworked students.

That is why I was pleased to hear the recommendations at the conference. Not only do I hope it catches on with other medical schools, but I hope it is looked at the other healthcare disciplines.  The sooner the students are educated, the sooner they can appreciate the science and research behind reducing medical errors.  I agree with the concept of integrating patient safety science into their traditional training. Having it as a separate course seems to create a bit of a disconnect between those principles and the everyday work the students will be engaging in.  I would imagine earlier and integrated lessons will build acceptance and promote a safer culture.

I'm curious to know if the Wisconsin course was unique or if there are others like it.  How was patient safety taught in your education, if at all?